| NPI | 1730271347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019025660) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: IN 12010885) |
| 1223P0300X Dentist Periodontics (Licence: IL 021002247) | |
| 1223P0300X Dentist Periodontics (Licence: MI 2901018231) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2024-01-25 |